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  1. Today in the World of RN Case Management

    I spent the past few days arranging the discharge of a client from the hospital. He needs to have IV Antibiotics for 2 weeks, and would need a home health agency to do some cares for him outside of a hospital. No problem. He was all set to go back to his group home, which made special arrangements with the staffing schedule so he would be able to stay home during the day (the home generally isn’t staffed from 8am-3pm because all the residents go to a day program). The social worker at the hospital was going to make arrangements with a home health agency to go to the group home every day for skilled nursing cares. Everything was going to be just fine.

    Until today. I get a call from the home owner saying the hospital can’t find a provider for home health care. Ok. There are like 6 gazillion companies that do this. That makes no sense. I called the social worker at the hospital, who redirected me to the intake coordinator for one of the providers where I found out…

    Medicare won’t cover outpatient IV antibiotics so, instead of going home with a home care agency in place to manage the PICC line, my client has to go to a nursing home for 2 weeks for absolutely no reason. Thousands of dollars difference in cost for care, in addition to an increased risk of infection, wounds, communicable diseases, and readmission to the hospital. Nursing homes are just lovely. You’re welcome, taxpayers.

    If you want to know why health care isn’t affordable, it’s because shit like this, and completely not like this but just as stupid, happens every day. More than once. One bill isn’t going to fix that. It’s not even going to scratch the surface. But, hey. At least everyone can at least be financially covered while some politicians pretend they’re going to do something to fix things. Don’t get me wrong. I think it’s great that everyone gets health insurance. I’m just not going to sit here and pretend that makes health care more affordable or fixes anything wrong with the quality of care. Or the lack of emphasis on prevention, education, and community health. Or the way things are billed. Or the way records are kept. Or the lobbyists that influence every single decision made by politicians. Or even the overall uneducated and/or non-compliant American population. Seriously. Do you know how much Type 2 Diabetes and its complications cost to manage and treat every year? A lot. Type 2 Diabetes and its complications are almost 100% preventable. Twenty per cent of antibiotics prescribed every year are completely useless.

    America’s got work to do and no one willing to do it.

    So, I guess we took a tiny step in the right direction. Great. That’s enough. The bigger issues are all the way over there. But at least we made a little progress.